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International audience; The purpose of this study was to examine the prognostic value of serum ECM biomarkers in hypertensive patients with no history of cardiovascular events. In a community-based cohort study of 125 hypertensive patients free of cardiovascular events, we collected clinical data and blood samples to assess serum levels of amino-terminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase type 1(MMP1) and tissue inhibitor of MMPs type 1(TIMP1). Left ventricular hypertrophy (LVH) was assessed using the ECG Cornell product. Patients were followed up for death or cardiovascular hospitalisation. We used Cox regression models to assess the prognostic value of ECM biomarkers. The sample included 60.8% women; the mean (±SD) age was 62.9 (±11.4) years. Patients were followed up for a median of 5.5 years, during which 23 events (five deaths) occurred. PIIINP (3.2 ± 1.0 vs. 2.6 ± 0.8 μg/L, P = 0.001) and TIMP1 (886 ± 168 vs. 751 ± 202 μg/L, P < 0.001) levels were higher in the presence of LVH than with no LVH. Basal MMP1 serum levels were significantly associated with CV events (MMP1: HR, 1.06; 95%CI [1.02-1.09]). Adjusting for confounders did not modify this result. Cardiac fibrosis, as assessed with serum ECM biomarkers, might develop early in hypertensive patients and is predictive of cardiovascular events or death.

International audience; Activation of the mineralocorticoid receptor has been shown to be deleterious in cardiovascular diseases (CVDs). We have recently shown that lipocalin 2 (Lcn2), or neutrophil gelatinase-associated lipocalin (NGAL), is a primary target of aldosterone/mineralocorticoid receptor in the cardiovascular system. Lcn2 is a circulating protein, which binds matrix metalloproteinase 9 and modulates its stability. We hypothesized that Lcn2 could be a mediator of aldosterone/mineralocorticoid receptor profibrotic effects in the cardiovascular system. Correlations between aldosterone and profibrotic markers, such as procollagen type I N-terminal peptide, were investigated in healthy subjects and subjects with abdominal obesity. The implication of Lcn2 in the mineralocorticoid pathway was studied using Lcn2 knockout mice subjected to a nephrectomy/aldosterone/salt (NAS) challenge for 4 weeks. In human subjects, NGAL/matrix metalloproteinase 9 was positively correlated with plasma aldosterone and fibrosis biomarkers. In mice, loss of Lcn2 prevented the NAS-induced increase of plasma procollagen type I N-terminal peptide, as well as the increase of collagen fibers deposition and collagen I expression in the coronary vessels and the aorta. The lack of Lcn2 also blunted the NAS-induced increase in systolic blood pressure. Ex vivo, treatment of human fibroblasts with recombinant Lcn2 induced the expression of collagen I and the profibrotic galectin-3 and cardiotrophin-1 molecules. Our results showed that Lcn2 plays a key role in aldosterone/mineralocorticoid receptor-mediated vascular fibrosis. The clinical data indicate that this may translate in human patients. Lcn2 is, therefore, a new biotarget in cardiovascular fibrosis induced by mineralocorticoid activation.

Background —The progression of hypertension during NO deficiency is associated with renal vascular fibrosis due to increased extracellular matrix (mainly collagen I) formation. The purpose of the present study was to investigate whether endothelin-1 (ET-1) is involved in this pathophysiological process. Methods and Results —Treatment of rats for 4 weeks with the NO synthase inhibitor N ω -nitro- l -arginine methyl ester (L-NAME) 50 mg · kg −1 · d −1 increased systolic blood pressure to 159±12 mm Hg. In animals treated with L-NAME, histological evaluation of renal sections revealed an increased formation of extracellular matrix (Masson’s trichrome), and specifically of collagens (Sirius red). A part of this fibrosis was attributed to abnormal collagen I presence, because mRNA expression of the collagen I α1 chain (reverse transcription–polymerase chain reaction) and procollagen I formation (radioimmunoassay) were increased 3- and 2.5-fold, respectively, in the renal resistance vessels of hypertensive animals. In subsequent experiments, we examined whether ET-1 was involved in activation of collagen I formation. mRNA expression (RNase protection assay) of preproET-1 and ET-1 content (radioimmunoassay) were 10-fold and 3-fold increased, respectively, in renal microvessels of rats treated with L-NAME. Interestingly, in these vessels, ET-1 (immunostaining) was colocalized with sudanophilic lesions. Bosentan, an ET receptor antagonist (20 mg · kg −1 · d −1 ), coadministered with L-NAME canceled the increased mRNA expression and synthesis of collagen I and attenuated the severity of renal vascular lesions without affecting L-NAME–induced high blood pressure. Conclusions —These data demonstrate that ET-1 synthesis is increased in renal microvessels when NO production is suppressed. In this model of hypertension, ET-1 is a major activator of collagen I formation in renal resistance vessels and participates in the development of renal fibrosis without affecting systolic blood pressure.